Cholesterol drug works but isn’t widely known

Q: I have hereditary high cholesterol and Type 1 diabetes. My endocrinologist was pushing me to take a statin. Because many people I know have side effects such as muscle pain, I resisted.

Finally, he said, “Let’s try Zetia.” I take it daily. It controls my cholesterol and I have no side effects.

Why is this medication not more widely known and prescribed? I have told many friends who have switched to it from a statin. They can’t believe how much better they feel.

A: Zetia (ezetimibe) works through a completely different mechanism than statins. Drugs such as atorvastatin, rosuvastatin and simvastatin interfere with the production of cholesterol by blocking a key enzyme (HMG-COA reductase).

Ezetimibe works by inhibiting the absorption of cholesterol from the digestive tract. The drug is generally well-tolerated with a relatively low rate of side effects, such as diarrhea, upper respiratory tract infections, sinusitis, joint and muscle pain, fatigue and liver enzyme elevations.

Many doctors add ezetimibe to statins to achieve desired reductions in LDL cholesterol. If your doctor is satisfied with the results you have achieved with Zetia alone, that’s great.

Q: I read with great interest your article on discontinuation of aspirin therapy. Many of us long-term aspirin users are now in limbo. I’m a healthy 71-yearold male who has taken an 81-milligram aspirin daily for 40 years for primary prevention. My doctor back then suggested it, and my current doctor will not advise me on whether or not to discontinue. Can you help?

A: For a drug that has been used for well over a century, aspirin is surprisingly controversial. Many doctors used to routinely recommend lowdose aspirin to prevent heart attacks. These days, though, many physicians reserve aspirin for people who are at high risk. The fear is that aspirin may increase the risk of bleeding.

Stopping aspirin may not be a simple matter, however. A Swedish study found that people who discontinued aspirin suddenly had an increased risk of heart attack or stroke (Circulation, Sept. 26, 2017).

Surgeons may ask patients to stop aspirin before major surgery to lower the likelihood of uncontrolled bleeding. This, too, is controversial (International Journal of Surgery, Nov. 15, 2013).

Sadly, there is no proven protocol for cutting back on aspirin.

Q: I’ve been on amlodipine to treat high blood pressure for years, but lately I’ve experienced several bouts of insomnia. It comes on without notice and leaves just the same. I’m experiencing a bout right now, so I went to see a sleep specialist. During the initial interview, as I was telling her what meds I took, she said amlodipine is a “sleep doctor’s enemy.” On your website, I’ve found others who have had this problem as well. Why aren’t patients warned about this side effect?

A: Insomnia is included in the side effect information for amlodipine. Other complaints include swelling of ankles, palpitations and fatigue. We agree that physicians and pharmacists should mention sleeping problems associated with medications.

In our eguide to Getting a Good Night’s Sleep, we list a number of over-thecounter and prescription drugs that can make sleeping more difficult. You also will find a variety of strategies to overcome insomnia. This online resource can be found under the Health eguides tab at Peoplespharmacy.com.

Talk with your primary care provider. He or she should be able to find a blood pressure medicine that does not interfere with sleep.